Failure to Ensure Nursing Staff Competency in Medication Administration, Enteral Feeding, and Infection Control
Penalty
Summary
Licensed nursing staff failed to demonstrate appropriate competencies and skill sets necessary to care for several residents, resulting in significant deviations from professional standards of nursing practice. For one resident with hypertrophic cardiomyopathy, vascular dementia, and hemiplegia, a nurse prepared and attempted to administer Carvedilol despite the resident's systolic blood pressure being below the ordered threshold. The nurse attempted to remove the Carvedilol tablet from a mixture of medications in applesauce but could not confirm the correct tablet was discarded, and subsequently administered the remaining medications. Additionally, the nurse used personal, non-approved blood pressure equipment to monitor the resident, and multiple medication administration errors were documented where Carvedilol was given despite blood pressure or pulse being below ordered parameters. This resulted in the resident experiencing low blood pressure and decreased responsiveness. Another resident with atrial fibrillation, dementia, and hemiplegia did not have gastric residuals checked prior to enteral feeding as required by physician order, and the head of bed was placed flat during active feeding, contrary to standards that require elevation to prevent aspiration. The same nurse failed to flush the feeding tube with the ordered amount of water before and after medication administration. During tracheostomy care for this resident, sterile technique was not maintained, as sterile supplies were placed on a non-sanitized surface and contaminated gloves were used to handle sterile suction tubing. For a third resident with cerebral palsy, epilepsy, and developmental motor disorder, enteral feeding tubing that had been left uncapped and undated was used after only being wiped with an alcohol pad, despite infection control standards requiring new, capped tubing if contamination is suspected. Review of the nurse's competency records showed completion of various trainings and skills fairs, but there was no documented assessment or follow-up regarding concerns about the nurse's ability to use specific equipment, such as the enteral feeding pump. These failures placed residents at risk for aspiration, infection, and medication errors, and resulted in at least one adverse outcome.